Provider Demographics
NPI:1518254713
Name:FAULKENBURY, LISA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:FAULKENBURY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:318-966-6480
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:312 GRAMMONT ST STE 411
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7403
Practice Address - Country:US
Practice Address - Phone:318-966-6480
Practice Address - Fax:318-966-6481
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN086553-AP06537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily